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1. Are MRIs and X-rays enough to diagnose the cause of back pain?

Lower back pain is one of the most common reasons why people visit their doctor or go to urgent care. Severe low back pain may lead you to think something is seriously wrong with your lumbar spine. It is common for most doctors to advise imaging tests like MRI or X-ray to determine the cause of back pain or the patients wanting it to relieve their concerns. These are useful if your problem is due to a structural issue in the spine. But most back pain cases are mechanical in nature or the cause is not serious like a strained muscle, sprained ligament or poor posture and Degenerative Disc Disease; that can be extremely be painful and possibly limit your activity level. In such cases, imaging tests like MRI & X-rays fails to show you the complete picture and are probably not necessary.

Imaging tests should be recommended or mandatory when there are serious symptoms or red flags. Neurological symptoms like radiating pain into the buttocks and legs; abnormal reflexes; sensations of tingling, numbness or weakness; foot drop; loss of bowel or bladder. Co-existing medical conditions like cancer, fever, osteoporosis, diabetes, recent infection, use of immunosuppressant or steroids, previous spinal fracture or spine surgery and unexplained weight loss.

Many lower back pain cases improve in days or a few weeks with medication (Pain-Killers) and conservative treatment including physical therapy. Rarely is sub-acute (pain lasting between 4 and 12 weeks) or chronic back pain (pain lasting 3 months or longer) an indication of an urgent lumbar spine condition.

X-rays are helpful for evaluation of fracture, bony deformity including degenerative changes, sacroiliitis, disc and vertebral body height, and assessment of bony density and architecture. To analyse soft-tissue or disc damage, computed tomography (CT) or magnetic resonance imaging (MRI) scans may be needed. An electromyogram (EMG) helps find nerve and muscle damage.

X-rays and imaging studies are generally used to confirm your symptoms and exam results to identify the source of pain. X-rays and CT scans expose you to radiation, which can increase cancer risk. That’s especially worrisome to men and women of childbearing age, because it can expose testicles and ovaries to radiation. Furthermore, the tests often reveal spinal abnormalities that could be completely unrelated to the pain. Those findings can cause needless worry and lead to unnecessary follow-up tests and procedures such as injections or sometimes even surgery.

MRI & X-ray images cannot distinguish between subtypes of back pain and chronic issues. MRI findings do not match with intensity of pain and disability in case of discogenic back pain. Interpretive errors by radiologists make these reports extremely subjective which, can directly impact the diagnosis, treatment and clinical outcomes. These are only a few of the many shortcomings of referring to imaging tests as the primary mode of diagnosis.

This is the reason why doctors combine all their findings like symptoms, physical examination and imaging tests to confirm a diagnosis and then recommend an appropriate treatment plan. These imaging tests are enough to diagnose the cause of back pain but due to its pros and cons as mentioned earlier it should be recommended only when necessary.Thus, implementing a selective approach to low back imaging would provide better care to patients, improve outcomes, and reduce costs.

These imaging tests do not adequately diagnose condition of degenerated tissues as they are done in static position. But, patients often experience pain when they perform a certain task like – bending, walking or sitting. This is why some doctors recommend a Spine Function Test to show a more complete picture with detailed functional analysis (strength, mobility & balance). A spine function test can help identify the weak areas of the musculature and help doctors develop a more targeted treatment plan.

Dr.Shriya Patel (PT)

2.Back pain -Temporary reliefand permanent solutions

Back pain is the most common problem, which can hamper our routine to a greater extent.Structures at the low back play a crucial role in our daily routine. The back muscles, spine, vertebrae, and the nerves contribute in almost every movement of ours. In standing and sitting the weight of the upper body is taken by the lower spine vertebra whereas the spine is supported with the back muscles. As our center of body falls slightly ahead of spine; also helps in maintaining the posture during movements.Many factors contribute either individually or together to cause back pain. The pain can range from a dull pain to a sudden shooting sensation. Pain can be abrupt due to activity- lifting heavy weight, twisting activity or can be developed overtime - due to degeneration of bones, weak muscles, muscle spasm, nerve compression. Sedentary lifestyle plays a major role in increasing the pressure at the intervertebral disc, changing spine curvatures leading to Muscle imbalance within the low back and lower limbs. There are cases of latent injury where a person bends down to pick a fallen object from ground and the back gives off.

Early addressing the pain and taking proper measures can help to prevent problem from developing and the need for medication and surgery. Pain can be managed by applyingice packs or heat packs; ice packs are beneficial to use immediately after an injury or strain. Heat packs also gives you relief from stiff or aching muscles. Wearing of braces or lumbar support belts during unbearable pain helps to give support and reduce the pain, but avoid wearing it whole day long as it weakens the muscles which provide stability hence reducing the core strength. It is difficult to move around with the pain, but it's better to take a walk because resting can make your muscles more hard or stiff. Strengthening the core muscles and improving the flexibility of joint to prevent the occurrence of pain and discomfort. Maintaining a good posture making some ergonomic changes at work station can be beneficial for the long-term effect.

Back pain is also often seen with problems like stress,depression and anxiety; help you with daily meditation and deep breathing exercises to get relief from it. Some recent studies show that smoking not only just damage your lungs but also has a systemic effect of weakening the back muscles. It says that chronic smokers are likely to have back pain compared to people who have never smoked; nicotine content in it causes the small blood vessels to constrict and decrease the blood supply to soft tissues.

In every low back condition diagnosing the exact cause is important. Complete medical history and physical examination leads to the diagnosis and helps to create the exercise program. Exercise program can differ from patient to patient as per the condition. The low back pain can be prevented by doing low impact exercises after every prolong inactivity. Simple stretches, simple movements such as range of motion exercises will help to prevent the low back pain.

Dr.Pradnya Pansare (PT)

3.CAN PILATES IMPROVE POSTURE AND HELP PREVENT BACK ACHE?

Pilates is a mind body intervention that focuses on core stability, posture, flexibility, strength, breathing and movement control. Pilates focus on posture and the control of body positions that is why Pilates is great for improving posture and giving long lasting relief from postural neck and back pains and strains.

We have been encouraged to stand up straight, sit straight and hold good postures since childhood. We have slumped, slouched or stooped back into our old position and habits. To maintain a good, upright, tall posture body has to fight against gravity. Fatigue of these anti-gravity postural muscles lead to back and neck pain along with poor posture.

Effectiveness of Pilates in correcting and improving the posture depends on the muscle’s optimal length-tension relationship. Pilates based exercises have been shown to promote changes in the habitual poor posture by enhancing spinal, scapular and joint flexibility and strengthening shoulder, lower back and abdominal musculature. Some studies show that physically active people have less chance of developing kyphosis, scoliosis compared to sedentary people. The Pilates method is effective in reinforcing efficient movement patterns and strengthening, which lead a good posture and decreases chances to develop neck and back. Pilates method effectively and efficiently works in persistent low back ache; apart of back pain, its benefits include improvement in strength, motor control, endurance, reduction in body fat percentage, fat mass and blood pressure.

Pilates exercises for back pain include core strengthening, good body alignment, gentle stretches for tight back and lower extremity musculatures, deep breathing exercises, back and shoulder strengthening, symmetry and balance.

Pilates is highly popular due to the way the exercises involved work to strengthen the core postural muscles, which are essential to supporting the spine. The principles of Pilates and some of the key focus areas are:
• Using mental focus to improve movement, efficiency and muscle control
• Teaching awareness of proper spine alignment
• Creating length, strength and flexibility in muscles
• Mat exercises are effective for patients who suffer from uncomfortable spine symptoms and conditions
• Pilates exercises focus on strengthening the trunk and hip muscles and increasing the flexibility of the spine and hips. They work well in combination with yoga exercises geared toward reducing back pain and improving posture.

DR. SKY SHARMA (PT)

4.Cervicogenic Headache (CGH)

Cervicogenic Headache is a secondary headache, chronic in nature, arises mainly from upper cervical joints and perceived over one or more regions of head and face. Incidence of CGH range up to 2.5% among general population & 15% to 20% of patients with chronic headaches. Prevalence of CGH is seen in 30 to 45 years with relatively equal incidence rate among both sexes.

Characteristics of CGH
• Unilateral
• Chronic & Episodic pain
• Ram’s Horn pattern Neck pain
• Exaggerated by neck movement or posture
• Tenderness over neck
• Neck Stiffness&Tightness of neck muscles
• Diffused shoulder and arm pain

Various cervical pathologies can stimulate nociceptive receptors of the head and neck intern stimulation of trigeminocervical nucleus to cause referred pain to the occiput and eyes.



Causes for CGH:
. C1- C3 Nerve root irritation
. Upper Cervical Injuries
. Arthritis
. Whiplash injuries
. Tumours & infection of cervical

Risk population: . Drivers
. Hair Stylists
. Manual Labour
.Software professionals

Practitioners use holistic approach to treat CGH especially with exercise regimes and manipulation therapy. The exercise regimes need to address strength and flexibility of muscles around the neck, scapulothoracic and shoulder by incorporating strengthening and stretching exercises.

The novel approaches of manipulation therapy had shown excellent recovery for CGH patients by using Headache SNAGS and Upper cervical traction. Incorporation of postural correction and postural stability exercise yielded excellent results among CGH patient.

The novel approaches of manipulation therapy had shown excellent recovery for CGH patients by using Headache SNAGS and Upper cervical traction. Incorporation of postural correction and postural stability exercise yielded excellent results among CGH patient.

Dr.Abhirami (PT)





5. DOES YOUR MATTRESS AND PILLOW WORSEN YOUR BACK AND NECK ISSUES?

Getting the proper support in the form of a good mattress and a supportive pillow, when you sleep can really make a big difference in your cervical and lumbar spine health. The right pillow is essential in keeping the neck in a supported position with neutral cervical alignment during sleep. If pillow is not supportive, the structures in the neck will be stressed and will worsen the existing neck condition. A pillow that is too high, too firm, too soft does not allow the neck to relax completely while sleeping.

Sleeping on an inappropriate mattress can be a prime reason of acute back and neck pain, mostly after waking up in the morning, along with morning stiffness which is very common after using a too soft mattress. Also, you are likely to feel very tired during the day, difficult to focus in work.

Along with the wrong/ inappropriate pillow and mattress, your sleeping positions also can be a reason of worsening back and neck issues. The safest position to be in your bed is either on your back or side.

The neck should be supported, head should be in neutral position in line with the rest of the body whether you are laying on your back or side. Sleeping on stomach is not a good habit, it might cause neck and back pain because the spine is arched/ stressed and head turned to the side.

A good pillow will keep the head and neck in good alignment with the body. If pillow is too big or too firm, it will raise your head out of alignment and if it is too soft it will give insufficient support to neck, so, its important to find the right balance. Best pillows are made from foam or polyfill. Feather pillows lose their shape and support after laying on them after a short period of time. Your pillow should be replaced every 2-3 years. If still it does not support your neck, you may try McKenzie Cervical Rolls. A good mattress also needs to be the right balance between firm and soft. If it is too firm, it may irritate the areas of spine that are in contact with the mattress and will cause continuous pressure on your back which may worsen your existing spine issues. When your mattress is too soft, it allows your body to sink into bad posture while you sleep. The right mattress should keep your spine parallel, not sagging or bowing also be supportive and comfortable according to your body weight and built throughout the night. Medium firm mattress greatly improves the quality of sleep in people suffering from chronic low back pain. Mattress also needs to be replaced periodically in 8 to 10 years.

Memory form is used in mattresses to conform to body shape, it allows the body to remain in its neutral shape and alignment which help to relieve pressure from entire spine. There is no single mattress style or type that works for all people with low back pain. Any mattress that help someone sleep without pain and stiffness is the best mattress for the individual. So, personal preference should ultimately determine what pillow and mattress is best.

DR. SKY SHARMA (PT)

6. What can cause Hand Pain and Numbness?

Hand pain and numbness is the most common yet most ignored symptom in the society. It is often confused by the overuse injuries in hand. The hand and fingers are controlled by a network of nerves that starts from the neck, in cervical spine. The nerve roots C5 to C8 and T1 travels down to shoulder, arm, forearm, hand and fingers. There are mainly three nervesmediannerve,ulnar nerve and radial nerve.

Pain and numbness may occur if any one or all the nerves are affected either in the course of the nerve or at any branch. Muscle spasm may lead to compression of nerve. The symptoms mayworsen during certain movements or activities, especially repetitive motions such as typing, kneading, and hammering. Awkward wrist posture, during sleeping also can increase the pain and numbness.

Causes: -
1. Cervical radiculopathy: - It is the compression of the nerve root at the spinal level due to improper posture, disc bulge or any physical injury.

2. Carpel tunnel syndrome: -compression of the median nerve at the wrist level.

3. Rheumatoid Arthritis:- this causes inflammation of joint which cause pain and numbness in hand.

4. Thoracic outlet syndrome:-it is a group of disorders that occur when blood vessels for nerves in the space between your collar bone and first rib (thoracic outlet)are compressed causing pain and numbness in shoulder arm and fingers.

5. Systemic causes: - Diabetes, Vit. B12 deficiency, Poor Diet.

Risk factors: - Age, Occupation, few medications, increase lordosis of cervical spine.

Treatment: -
Physiotherapy treatment works well in such conditions. The main aim of the treatment is to reduce the pain numbness and increase the joint mobility.

The physiotherapy treatment includes: -

1. Pain Reduction.
2. Releasing the muscle spasm.
3. Stretching of neck, arm, forearm and hand muscles.
4. Muscle strengthening.
5. Postural Correction.
6. Splinting and using guards for further damage to nerve.
7. Neural tissue mobilization.

Balanced Diet, Vit B12 supplements improve the systemic body conditions reducing the symptoms. Surgery may be the last option if non-surgicaltreatment doesn’t work.

Dr. Pradnya Pansare (PT)

7. How does regular exercise reduce chronic pain on back?

Chronic pain is defined as pain lasting beyond normal tissue healing time, generally considered to be more than 12 weeks. It contributes to disability, anxiety, depression, sleep disturbances, poor quality of life, and healthcare costs. The stress of persistent pain quickly takes a toll on the body; muscles tighten and become stiff, making even the simplest tasks difficult. Our tendency to stop moving when we hurt is a protective human reflex, but it deconditions muscles and perpetuates pain. Although resting for short periods can help with pain, too much rest may actually make it worse and put you at greater risk of injury.

For many years, the treatment choice for chronic pain included recommendations for rest and inactivity. However, exercises have shown specific benefits in reducing the severity of chronic pain, as well as more general benefits associated with improved overall physical and mental health, and physical functioning.

Research has shown that regular exercise can ease pain long term by improving muscle tone, strength, and flexibility. Whether suffering from the first bout of low back pain or following extensive treatments or even surgery, the best way for patients to avoid or minimize the severity of recurrences is to rehabilitate the back through appropriate back exercises.

Benefits of Exercise:
When done in a controlled, progressive manner, exercises for relieving back pain have many benefits, including:
• Strengthening the muscles that support the spine, removing pressure from the spinal discs and facet joints
• Alleviating stiffness and improving mobility
• Improving circulation to better distribute nutrients through the body, including to the spinal discs. It helps to speed up the healing process.
• Releases endorphins, which can naturally relieve pain “Body’s natural painkiller”. A frequent release of endorphins can help reduce reliance on pain medication. Endorphins can also elevate mood and relieve depressive symptoms, a common effect of chronic pain.
• Minimizing the frequency of back pain episodes, and reducing the severity of pain when it does occur; thereby improving overall day-to-day functionality.


How exercise helps to relieve pain:
Engaging in exercise and fitness activities helps keep the back healthy by allowing discs to exchange fluids which is how the disc receives its nutrition. A healthy disc will swell with water and squeeze it out, much like a sponge. This sponge action distributes nutrients to the disc. In addition, fluid exchange helps to reduce the swelling that occur naturally in other soft tissues surrounding the injured discs. When there is a lack of exercise, swelling increases and discs become malnourished and degenerated. Exercising the back reduces stiffness by keeping the connective fibres of ligaments and tendons flexible. Improved mobility through back exercise helps to prevent the connective fibres from tearing under stress, which in turn prevents injury and back pain. Another important effect of exercise is that it stretches, strengthens, and repairs muscles that help to support the back. The back and abdominal muscles act as an internal corset supporting the vertebrae discs, facet joints, and ligaments. When back and abdominal muscles are weak they cannot support the back properly. Back & core strengthening exercises help to strengthen these muscles in order to prevent straining of soft tissues (e.g. muscles, ligaments, and tendons) and provide sufficient support for the structures in the spine.

What exercises to do?
Back exercises are almost always necessary to rehabilitate the spine and alleviate back pain. A controlled, gradual exercise program that is tailored to an individual is usually the most effective.

Studies have shown a general exercise programme which combines muscular strength, flexibility and aerobic fitness to be beneficial for rehabilitation of non-specific chronic low back pain.

• Stretching – Lower back, glutes, piriformis, & hams.
• Back strengthening exercise
• Core strengthening exercise
• Pilates & Yoga
• Low impact aerobic (Cardiovascular) exercise – Walking, Stationary cycle.
• Aqua therapy
Dr.Shriya Patel (PT)

8. Is core strengthening important for reduction in back ache?

What is your core?
When most people think about the core of the body they think of the abdominal or six-pack area just below the ribs. While the abdominal muscles are an important part of the core, it includes a lot more. The core of the body is broadly considered to be torso.

The core includes:
• Front abdominal muscles — The rectus abdominis
• Muscles along the sides of your body — The internal and external obliques
• A deep muscle that wraps around the front lower abdominal area — The transverse abdominis
• Muscles in your back that are located between your spine bones and run along your spine — The erector spinae and multifidi
• Deep abdominal / back muscle – Quadratus Lumborum
• Cervical muscles - Rectus capitus anterior & lateralis, Longus coli
• The core also includes the diaphragm, muscles of the pelvic floor & gluteal muscles.

If you suffer from back pain, you’ve probably heard that strengthening your core can bring you some relief. But is this always true.

The Significance of Core Strength:
If you think about it, your core is in the centre of your body. It needs to be strong to support the weight of your entire body, including your back and neck. This is especially important for low back pain sufferers, adding core strengthening to your exercise routine can help prevent or reduce your back pain. By boosting your core strength it will help in maintaining your posture, spinal alignment, balance, and stability.It's essential for overall movement effectiveness, quality of life and injury prevention.

Many people have back pain whether it's upper back pain or low back pain which may be partly caused by weak abdominal muscles. Since your abs are the front anchor of your spine, if they are weak, then the other structures supporting your spinewill have to work harder. By developing stronger core muscles, you'll be less likely to injure or strain your back muscles as they take the pressure off your back (from structures like spinal vertebras & discs) and help align your spine.

As our body miraculously compensates for muscular weakness, if your core muscles are weak, your body will rely on muscles, ligaments, tendons, and spinal discs to keep you sitting or standing upright. Chronic strain on these structures tends to create poor posture and pain in the back and hips.

Strengthening all of these muscles reduces the strain on your back and helps relieve or prevent pain. These muscles provide stability to your trunk. They keep your bones aligned properly so that there are no abnormal stresses on your joints. A strong core also helps your balance, which will prevent falls and enable you to exercise and conduct daily activities easily.

It's important to incorporate exercises that work all of your abdominal and core muscles equally. Your core most often acts as a stabilizer and force transfer centre rather than a prime mover. Yet consistently people focus on training their core as a prime mover and in isolation. This would be doing crunches or back extensions versus functional movements like deadlifts, overhead squats, and push-ups, among many other functional closed chain exercises.Studies have shown that core stabilization exercise is more effective than routine physical therapy exercise in terms of greater reduction in pain in patients with non-specific low back pain.

Thus, a strong core is your best guard against back pain although the idea of core strengthening, while beneficial, is just another piece of the low back pain puzzle.

Dr.Shriya Patel (PT)

9. IS NON-SURGICAL TREATMENT EFFECTIVE FOR HERNIATED DISC?

Most cases of herniated disc resolve on their own within 6 weeks, patients are often advised to start to start always with non-surgical treatment.

Controlling the intense pain in initial stage of herniated disc is the most urgent need.Pain control options are likely to include:
• ICE application- cold packs Le help in reducing inflammation and muscle spasm
• Pain medication- nonsteroidal anti-inflammatory such as Ibuprofen or Naproxen to treat pain and inflammation.
• Muscle relaxant- muscle spasm may accompany a lumbar herniated disc.Muscle relaxant may offer relief from painful acute muscle spasm.
• Heat therapy- after 48 hours moist heat can be helpful to reduce pain and spasm.
• Bed rest- bed rest for severe pain is best at least for 2 to 3 days.
• Epidural injection- An epidural steroid injection is intended to provide enough pain relief for the patients to make progress with rehabilitation.
• Physical therapy- stretching and strengthening exercises can help to reduce pain and help in fast recovery from herniated disc along with the exercises, teach the patient safer ways to perform ordinary activities such as sitting, walking and lifting.
• Spinal manipulations- may also ease pain and provide a better healing environment.
• Traction/non-surgical decompression- it helps to decompress the spine and nerves. Very helpful in radiating disc pain.
• Acupuncture/dry needling- again a method to relieve pain.
• Cognitive behaviour therapy- CBT helps people control and change self-defeating behaviours.
• Massage therapy- can ease the back pain by increasing blood circulation, relaxing muscles and releasing the endorphins(natural pain relievers).

So, finally I would say yes, non-surgical treatments are very effective in treatment of herniated disc and it must be a first line of treatment, if it fails then we should think about other surgical options.

DR.SKY SHARMA (PT)

10.Is Surgery Required In Degenerative Diseases?

In my opinion, degenerative disc disease isn’t actually a disease. The term “disease” often carries a negative tone, but the reality is that degeneration of your intervertebral discs is actually a natural part of the aging process. It’s just that some people respond differently to this process.

Healthy discs are well hydrated but, with the age they can become dehydrated. This can result in weakened, stiff and rigid discs which may change the way your spine moves, causing back pain, nerve problem and other degenerative disc diseases symptoms.

Surgical treatment is an option in cases of severe, debiliting lumbar degenerative disc disease, and is usually only recommended after at least 6 months of non- surgical treatment. Most of cases of degenerative disc diseases can managed using non-surgical methods and do not require surgery for effective pain relief. However, if you develop significant nerve problems or loss of bowel and bladder control, which is the serious disorder called cauda equine syndrome, surgery may be required.

Your doctor has probably mentioned the importance of exercise and the need to strengthen your abdominal muscles and that helps to reduce stressfrom your disc, which can affect the muscles and ligaments that connect these bony structures.

Strong core muscles can help to support degenerated disc. And fortunately, when it comes to preventing degenerative disc diseases from getting worse, you have several treatment options in addition to exercise. Work with your doctor to create a treatment plan for your degenerative disc diseases- one that include combination of exercise, physical therapy and medication.

Dr. Vinit Dhokchaule (PT)

11. Lower back pain in athletes

Introduction:
Both the sedentariness and very high levels of physical activity have been related to low back pain in adolescence. Low back pain in an athletic population is not uncommon, and its occurrence has been well documented in various sports including football, golf, gymnastics, running, soccer, tennis and volleyball. Two major attributed reasons for low back pain amongst athletes are acute microtrauma, microtrauma / repetitive stress or from combination of these two mechanisms. Especially athletes with lower extremity overuse or acquired ligamentous injuries weresignificantly more likely to require treatment for low back pain during the ensuing year. Various other factors associated with low back pain in athletes could include poor muscle endurance, altered muscle firing rates, muscular imbalance, in flexibility or leg length discrepancy.

Hence lower back pain is a significant problem not only for athlete adults but also for young generation, however the relationship between lower back pain during youth and the duration for types of competitive sports differs.

Epidemiology:
Evidence-based research studies conclude that extensive exposure to competitive sports activities during youth was associated with low back pain with the severity varying with the sports. In the growing individual, especially during the rapid growth phase, the skeleton mainly the growth zones and apophyses is more vulnerable to acute trauma and injuries stemming from over use than in the adult skeleton. Further, injuries affecting the intervertebral discs, end plates or ring apophysis also contribute to the degenerative process early.

The effects of intensive physical loading on and injuries to lower back during the adolescent growth spurt varies a lot. At this age, the low-back structures are liable to develop anatomic changes, which may contribute to low back pain and degeneration in adulthood.

With regard to muscular influences on LBP, the hip musculature plays a significant role in transferring forces from the lower extremity up toward the spine during upright activities and thus theoretically may influence development of LBP. For endurance and delayed firing of hip extensor group- the glut (GluteusMaximus), abductor muscle (gluteusmedius) have previously been noted with individuals with lower extremity instability and low back pain.

Gender specific strength differences have also been noted, significant asymmetry in hip extensor strength in female athletes with reported low back pain in the previous year.

Hence, from above literature it is clear that even sports player are prone to develop lower back pain.

Treatment Options:
The general categories of treatment for low back pain are medications and therapies. Nonsteroidal anti-inflammatory medications, skeletal muscle relaxants have the strongest evidence of benefits yet physiotherapy treatments show a significant role to focus on muscle imbalances or any early degenerative changes if occurring. Pain management includes superficial heat, modality-based treatments, LASERs for healing purpose and various Spinal manual therapies along with a curated and tailor-made exercise program for the athlete.

Dr.Mansi (PT)

12. Novel treatment for Osteoarthritis of knee

Overview of OA knee:
OA is known as degenerative disease and commonly referred as wear and tear, in which the natural cushioning between joints-cartilage wears away. Due to this, the bones of the joints rub closely against one another resulting in pain,swelling,stiffness,decreased ability to move and sometimes leading to formation of bone spurs.



Who gets OA knee?
Several factors increase the risk of developing significant arthritis at an older age.
1) Above 45 years old
2) Gender usually women are more likely to be affected
3) Overweight
4) Heredity
5) Repetitive stress injuries
6) Affected by any other disease, such as rheumatoid arthritis, gout.

What are the symptoms?
The severity of symptoms varies from person to person with some feeling mild discomfort which come and go and others suffering continuous debilitating pain which makes them difficult to do daily activities.

Imagine waking up in the morning and falling back down on the bed as soon as you stand because your knees cannot immediately support your weight due to pain and swelling resulting in joint stiffness and tenderness in the joint area followed by a grating sensation known as crepitus which occurs while moving the affected joint. Further, this pain is aggravated by muscle weakness, decreased range of motion, poor alignment of knee, hip and ankle.

How can OA knee be treated?
There are various treatment options available, but it depends on number of factors needed to your body. These includes your medical history, level of pain, and impact of OA on your daily life. in most cases, treatment includes a combination of therapies, as well as healthy lifestyle modifications.

Healthy habits:
1) Diet is one important measure considered in OA patients in which balance diet food such as rich in vitamins, omega 3 fatty acids and antioxidants are essential.
2) Consuming water is essential step towards reducing arthritis pain and helping your body to respond well to exercise.
3) Many times, the first line of treatment is exercise and weight reduction to decrease the pain and improve the joint mobility.
4) People with arthritis wearing a wrong footwear can exacerbate the problem that already exist and contribute in long term damage to joints, muscles, ligaments and tendons. Right shoes can minimize pain and maximize the ability to do daily activities.

Various treatment approach:
Many treatment regimes include combination of exercise and assistive device or surgery along with medications.

1) Medications: painkillers, paracetamol, NSAIDS are prescribed but long-term results have side effects.
2) Intra-articular injections are also prescribed such as hyaluronic acid which acts like lubricant and shock absorber and for this right selection of patient is important and not beneficial for all.
3) A proper physical therapy regime has depicted a benefit over long period of time in conjunction with tailored home exercise program to reduce the symptoms. The major goals of the intervention are to decrease pain, improve function and prevent disability thereby enhancing the quality of life.

There is various physiotherapy treatment program associated in managing the symptoms such as:
• improving flexibility and joint motion
• focusing on the muscles by enhancing the strength as well as building a strong core muscle function which further helps in improving the balance.
• Manual therapy technique such as mobilization and manipulation help to decrease the pain and improve function.
• Therapeutic modalities and dry needling for pain relief.
• Taping technique to unload the pain sensitive areas
• Guiding the use of proper assistive device such as braces, canes etc.

And other than these treatments, there’s a highly effective treatmentcalled ESWT (Extracorporeal Shock Wave Therapy) which we use in our setup.In this high energy sound waves are introduced to the painful areas of the body therefore the therapy eliminates the pain and thereby restoring full mobility and improving quality of life.

In severe cases, surgery would be the option for instances knee arthroscopy, partial or total knee replacement.

OA knee prevention:
1) Keep a healthy body weight
2) Control your blood sugar
3) Prevent injury to your joints
4) Pay attention to pain
5) Active Exercises play an important role as they cause a release of endorphins thereby triggering a positive feeling to the body as well as energizing a person’s life.

Recent study:
https://pubmed.ncbi.nlm.nih.gov/32268027/ physical therapy versus glucocorticoid injection for osteoarthritis of knee.

This study had 156 patients suffering from OA knee.They were randomized into two groups one with physical therapy and other for injection group. In the physical therapy group exercise include stretches, knee extension, squats etc. the other group had initial injection and follow ups at 4th and 9th month. WOMAC score were used for assessment. Conclusion: the physical therapy group that less pain and functional disability at 1 year than patients who received intra-articular glucocorticoid injection. Dr.Roshini Menon (PT)

13. Pregnancy and low back pain

Pregnancy related low back pain is a common complaint that occurs in 60-70% of pregnancies. and can be defined as pain between the 12th rib and the gluteal folds/pubic symphysis during the course of pregnancy, possibly radiating to the posterolateral thigh, to the knee and calf, but not to the foot. This pain is not the result of a known pathology such as disc herniation and can begin at any point during pregnancy. Although most cases are mild, approximately one third of women experience severe pain. Several factors have been associated with the development of low back pain during pregnancy.

• Mechanical- Caused due to Relaxin Hormone which causes ligament laxity, and therefore can affect the stability of the spine and lead to back pain.
• Hormone- hormonal changes during pregnancy can cause inflammation and pain in the back.
• Circulatory-The expanding uterus can press on the vena cava, particularly at night when the patient is lying down. The pain is possibly severe enough to wake the patient up. This combined with the increased fluid volume from fluid retention during pregnancy leads to venous congestion and hypoxia in the pelvic and lumbar spine.
• Psychosocial -Psychosocial factors can also increase low back pain. Pain-related catastrophizing, depression, pain intensity and time result in an increases in pain interference.
Although there are numerous interventions promoted for low back pain during pregnancy, the most common and widely used is a specific exercise program designed by a physiotherapist. Management includes specific interventions to address pain, weakness, and mobility in the low back region

Dr.Rashmi Mathur (PT)

14. Say No to painkillers

Many people experience Physical discomfort at the low back. It is the most common condition in today’s world.Research done on this condition concludes that 75% - 80% of people out of total population, suffer from back pain once in their lifetime, whereas 50% will have more than one episode in a year. Physical discomfort occurring at the lower back may be due to structures surrounding the spine such as – vertebral bodies, intervertebral disc, ligaments, muscles, nerves that make up the spine. Back pain being a common symptom can be caused due to repeated lifting of heavy objects, prolonged sitting, sleeping in awkward position, poor muscle strength etc.

Commonly painkillers are chosen as the first line treatment for back pain, but these medications only mask your symptoms they don’t treat the root cause of your pain. Too much dependency on these drugs can lead to addiction which will have adverse effects on your body’s endocrine system. You develop a tolerance to the medication over the period of time, your pain can actually get worse with long time dosage.Ointments are another popular but harmful options.They stimulate the sensory nerve after application,hence a patient feels temporary relief. Seeing that painkillers are not helpful rather harmful to our body,it also worsen the condition and increases the pain in long term. You might avoid your back pain or prevent its reoccurrence by improving your physical condition to keep your back healthy and strong.

Physiotherapy treatmentwill help you to reduce your pain by applying various electrotherapy modalities. Once the pain reduces, a physiotherapist will guide you with following things to help to improve condition without reoccurrence. A gradual exercise treatment is tailored as per the diagnosis. Following are the treatment benefits:-

• Alleviating the muscle tightness.
• Maintaining the flexibility of low back, hip and thigh
• Strengthening of abdominal and back muscles can improve your posture giving it straight alignment.
• Regular low impact aerobic activities which will not strain your back can increase strength and endurance to allow your muscles to function better.
• Maintain a healthy weight- Being overweight can strain your back so eat healthy and nutritious to maintain your ideal wright Ergonomic Solutionsalso helps in reducing the pain and improving the quality of life. Only few people need surgery for back pain. The surgery is done only if a patient doesn’t respond to other therapies, such as shooting and radiating pain, muscle weakness due to nerve compression and herniated disks.

Avoid pain killers and adopt healthy way of caring your back.

Dr.Pradnya Pansare (PT)




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